Introduction: Lumbar disc herniation (LDH) in the pediatric population is rare and different from adults, in which the etiology is often degenerative in nature. Few have investigated the safety and efficacy of a tubular approach to minimally invasive (MIS) microdiscectomy for the treatment of pediatric LDH.

Methods: Twelve consecutive pediatric LDH patients treated with tubular MIS microdiscectomy at one institution between July 2011 and October 2015 were included in this study. Electronic medical records were retrospectively reviewed. Mcnab criteria and Oswestry Disability Index (ODI) were utilized as outcome metrics.

Results: The mean age at surgery was 17 years (range 13 - 19), there were 7 girls and 5 boys. Prior to surgery, 100% underwent conservative treatments for a median of 9 months (range 1 - 36). Pre-operative signs and symptoms of low-back/leg pain, positive straight leg raise, and myotomal weakness were notable in 100%, 83%, and 67%, respectively. The level of LDH was L5-S1 and L4-L5 in 75% and 25%, respectively. The mean operative time was 90 minutes, the estimated blood loss was less than or equal to 25 mL in 92% (max 50 mL), and there were no intra-operative complications or at 30 days. The median follow-up time was 2.15 years (range 0 - 5.6). One patient required a revision operation 18 months after the initial operation. At the last follow-up, 91% were excellent or good by the Mcnab criteria, while one was fair. Six patients (50%) completed an ODI, for whom the average ODI disability score was 17%, indicating minimal interference in quality of life overall.

Conclusions: To our knowledge, this series is only the second and largest of its kind, and provides further evidence that tubular MIS microdiscectomy is safe and efficacious in treating pediatric LDH. Nevertheless, larger studies with longer follow-up are needed to better evaluate long-term outcomes.

Patient Care: This study provides further evidence that tubular minimally invasive microdiscectomy is safe and efficacious at treating pediatric lumbar disc herniation. These findings may broaden the viable treatment options for patients with severe refractory disc herniation disease whose quality of life could significantly improve with minimally invasive surgery.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the safety and efficacy of tubular minimally invasive microdiscectomy for the treatment of pediatric lumbar disc herniation.

References: 1. Fairbank JC, Pynsent PB: The Oswestry Disability Index. Spine (Phila Pa 1976) 25:2940-2952; discussion 2952, 2000 2. Macnab I: Negative disc exploration. An analysis of the causes of nerve-root involvement in sixty-eight patients. J Bone Joint Surg Am 53:891-903, 1971 3. Slotkin JR, Mislow JMK, Day AL, Proctor MR: Pediatric Disk Disease. Neurosurgery Clinics of North America 18:659-667, 2007 4. Thomas JG, Hwang SW, Whitehead WE, Curry DJ, Luerssen TG, Jea A: Minimally invasive lumbar microdiscectomy in pediatric patients: a series of 6 patients. J Neurosurg Pediatr 7:616-619, 2011